This disclosure relates in general to health information and healthcare and, more specifically, but not by way of limitation, to healthcare assurance systems.
In general, the model for healthcare payment is not pay-for-services, not how many lab tests are performed, and not how many procedures, but to pay for appropriate care for a patient. The model is changing from pay for service to paying a bundled rate. When healthcare payers (e.g., the government) start paying that way, as opposed for there to be financial incentives to overutilize services, there are financial incentives to underutilize services. Healthcare payers, such as the government, recognize that more complex cases warrant greater use of resources, and, consequently, they pay more if the case is more complex.
However, the current state of medical records, generally, is fraught with inconsistencies, inaccuracies, isolations, and other difficulties. Patients often receive care from a multiplicity of healthcare providers and, as a result, have a multiplicity of medical records. All this contributes to the difficulty of ensuring that critical information, particularly information relating to complex medical conditions, is identified, reconciled, and properly addressed to ensure that patients are given appropriate treatment and that payers cover the costs appropriately.
There is a need to facilitate enforcement of appropriate utilization of healthcare services, generally. And, in particular, there is a need to facilitate enforcement of appropriate utilization of healthcare services in more complex cases. Situations where a patient is not getting appropriate care need to be identified and addressed.